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Case managers have stacks of complaints

Recently, the North Florida Coalition of Home Medical Equipment providers coordinated a meeting between several of the largest hospital systems in North Florida, along with some nursing facilities and the local offices of Sens. Bill Nelson and Marco Rubio, and Rep. Ander Crenshaw. Our coalition has been very active in communicating the competitive bidding issues with our lawmakers; however, we felt it was time that they heard from the case managers and nurses themselves (the horse’s mouth).

The floor was opened to the referrals to talk about the problems they were having with the program. Among their answers:

• Delayed discharges

• Readmits because patients were not receiving needed equipment (pointing out that Part A spending increases)

• Hospital referrals are having to wait seven to 10 days for orders to be filled.

• Skilled nursing facilities (SNFs) are having to wait two to three weeks for their orders to be filled.

• Hospitals and SNFs are being told to do all of their own pre-certifications, including labeling all HCPCs.

• Referrals have made complaints directly to the CBIC; however, they see no consequences for the contract suppliers and access has not improved. Contract suppliers are telling referrals they have to be more patient. Contract suppliers are telling referrals that equipment is on back order.

• Referrals are being told that deliveries are limited to the hours of 8 a.m. to 5 p.m.

• Referrals are being told that deliveries are limited to zip code areas (excluding some zip codes that are clearly part of the contract they won).

• Referrals are being told that deliveries are limited to weekdays only.

• Referrals are being told by the winning provider that a part of the order can be filled, but not the entire order.

• Referrals are having to obtain multiple companies for one patient’s needs.

• Patients and/or their families are blaming the hospital case managers when equipment hasn’t been delivered after discharge. One contract supplier is telling patients that the hospital isn’t sending the orders and that is why there is a delay in getting the equipment.

The meeting went very well and the case managers from the hospitals and rehab facilities were very blunt in talking about access issues under this flawed program. The case managers explained to the lawmakers that before this program started on July 1st, they could get medical equipment for their patients within hours any time of the day or night. Now all of that has changed.

Due to the problems that are occurring in the Jacksonville competitive bidding area (CBA), case managers were not surprised to see studies showing that 80% of the contract suppliers in the CBA were out-of-area providers who were not servicing the area prior to July 1st, and that approximately 75% of the winning providers for walkers and hospital beds were still not capable of servicing the area three months into the program. One hospital stated that they contacted every winning provider for the Jacksonville CBA and found that most were not capable of servicing the area. The lawmakers found this very disturbing.

I then showed everyone a copy of the response letter I received from the deputy director at CMS concerning my testimony about competitive bidding to the Small Business Administration. In the letter, the deputy director states in paragraph five that CMS conducts an evaluation of expansion plans to verify the supplier’s ability to provide items and services in the CBA on day one of the contract period. The letter also states that one important contract term and beneficiary protection is the requirement that contract suppliers must service the entire CBA. These statements by the deputy director obviously contradict what is actually happening with in the program.

At the end of the meeting, we asked that the Senate offices introduce a companion bill to H.R.1717, which would replace the competitive bidding program with a market-pricing program (MPP). We also asked that a hearing be conducted that includes testimony from case managers, nurses and other healthcare professionals on the program and how it is affecting patient care. The case managers at our meeting had stacks of email complaints that they will also be forwarding to the offices, which debunks the claim by CMS that there are only 33 complaints nationally.